Who is most at risk
Women who have had depression before, postnatal depression, or severe premenstrual symptoms. Women with severe hot flushes and broken sleep. Women carrying heavy stress: caring for children and ageing parents, work pressure, relationship strain, financial pressure.
Anxiety and irritability
New anxiety, panic attacks and short temper are common in perimenopause. They often track the cycle and the hormone swings. Many women are treated for anxiety without anyone asking about their periods.
Treatment
In perimenopause, hormone therapy can improve depressive symptoms, especially alongside hot flushes and poor sleep. It is not a replacement for antidepressants in established depression.
Antidepressants and cognitive behavioural therapy remain first line treatments for depression. Venlafaxine and escitalopram treat low mood and hot flushes together.
Exercise three to five times a week, treating sleep, and cutting alcohol all reduce symptoms.
Serious mental illness
Midlife hormone change can destabilise bipolar disorder and psychosis. Women with these conditions need closer review through the transition.
See a practitioner if
- Low mood lasts more than two weeks
- You stop enjoying things you used to
- Anxiety stops you working or going out
- You have thoughts of harming yourself
Common questions
Is it depression or menopause?
It can be both. Your practitioner should ask about mood and about your cycle and hot flushes. Treatment is chosen to fit both.
Will hormone therapy fix my mood?
It helps some women in perimenopause, particularly when hot flushes and sleep are driving mood. It is not proven to treat depression after menopause.
Where can I get help urgently?
If you are thinking about harming yourself, call emergency services or a crisis line now. In Australia, call Lifeline on 13 11 14. In the United Kingdom, call Samaritans on 116 123. In the United States, call or text 988.
Sources
- The Menopause Society and National Network of Depression Centers, guidelines for perimenopausal depression, 2018
- Study of Women's Health Across the Nation, mental health findings
- International Menopause Society, white paper on menopause and mood
This page is education, not medical advice. Talk to your doctor or menopause practitioner about your own care. In an emergency, call your local emergency number.